Diabetes Risk Driven by Economic Disparity in Hispanic, Latino Communities

Hispanic and Latino adults found that while preserving cultural identity may initially benefit health, socioeconomic factors like education level significantly impact diabetes and hypertension rates, highlighting the need for targeted health interventions across diverse subgroups. | Image Credit: Minerva Studio - stock.adobe.com

Hispanic and Latino populations have high rates of diabetes and hypertension in the absence of improved economic opportunities, highlighting the complex interplay of acculturation and socioeconomic factors within these diverse communities, according to a study published in JAMA Health Forum.¹

Hispanic and Latino communities have increased risks of diabetes, obesity, uncontrolled hypertension, and higher death rates from diabetes. Despite these disparities, Hispanic and Latino adults experience a lower prevalence of cardiovascular disease morbidity and mortality and maintain a longer life expectancy compared with White individuals in the US. The time spent in the US or adapting to US lifestyle and culture, known as acculturation, heavily links immigrant health.

The "Hispanic Mortality Paradox" describes the paradoxical finding that the Hispanic population in the southwestern US experienced similar health outcomes to the non-Hispanic White population despite their lower socioeconomic status.² Subsequent research expanded on this finding and revealed that the "Hispanic Mortality Paradox" reflects better mortality outcomes in the Hispanic population compared with the non-Hispanic White population, not just similar ones. Hispanic and Latino immigrants arrive in the US with an initial health advantage that erodes over time and across generations.¹ Researchers speculate that acculturation leads to the loss of the immigrant health advantage and increases the prevalence of chronic diseases.

Researchers aimed to identify acculturation and socioeconomic factors that are associated with the risks of diabetes and hypertension among Hispanic and Latino individuals from different heritages within the framework of segmented assimilation using data from the Hispanic Community Health Study/Study of Latinos.

The study included 11,623 adult participants, of whom 10.4% were of Central American heritage, 14.2% were of Cuban heritage, 8.8% were of Dominican heritage, 41.3% were of Mexican heritage, 15.5% were of Puerto Rican heritage, and 6.8% were of South American heritage. Participants had a mean age of 43.1 years, and 56.3% of them were women. There were 71.4% of individuals in the overall cohort who were born outside of the US or US territories. Additionally, 58.3% of the Hispanic and Latino participants were less acculturated.

Central American (39.2%), Dominican (39.8%), Mexican (37.5%), and Puerto Rican (36.4%) individuals more commonly had less than a high school level of education. Cuban (50.8%) and South American (53.2%) individuals more frequently obtained a high school degree or equivalent.

Dominican individuals (19.6%) and Puerto Rican individuals (19.7%) showed the highest prevalence of diabetes, while Cuban individuals showed the lowest (13.8%). Conversely, Mexican individuals (31%) and Puerto Rican individuals (31.5%) showed the highest prevalence of diabetes at visit 2, while Cuban individuals showed the lowest (21.3%). Mexican individuals (17.2%) and Puerto Rican individuals (16.6%) experienced the highest incidence of diabetes, while Central American individuals (10.2%) and Cuban individuals (11.4%) experienced the lowest.

Across all heritages, hypertension increased from 27.4% at visit 1 to 35.3% at the second visit (visit 2). Puerto Rican (33%), Dominican (32.7%), and Cuban (30.8%) individuals exhibited the highest prevalence of hypertension at the first visit (visit 1). Dominican (41.7%) and Puerto Rican (41.7%) individuals maintained the highest prevalence of hypertension at visit 2. Dominican individuals experienced the highest incidence of hypertension (27.1%).

More education lowered the risk of diabetes and hypertension, regardless of acculturation, and greater acculturation lowered the risk of incident diabetes. At visit 1, less acculturated individuals with lower socioeconomic status showed the highest prevalence of diabetes (20%), while more acculturated individuals with higher socioeconomic status showed the lowest (14.1%). At visit 2, less acculturated individuals with lower socioeconomic status still showed the highest prevalence of diabetes (30.5%), but less acculturated individuals with higher socioeconomic status showed the lowest (22.7%). More acculturated individuals with lower socioeconomic status and less acculturated individuals with lower socioeconomic status experienced the highest incidence of diabetes (16.8% and 16%, respectively).

Segmented groups showed a similar prevalence of hypertension at visit 1 (range, 25.7%-29.2%). More acculturated individuals with lower socioeconomic status exhibited the highest prevalence of hypertension at visit 2 (38.5%), while more acculturated individuals with higher socioeconomic status exhibited the lowest (30%). Less acculturated individuals with lower socioeconomic status experienced the highest incidence of hypertension (22.2%), and more acculturated individuals with higher socioeconomic status experienced the lowest (12.6%).

Acculturated participants with higher socioeconomic status showed a significantly lower weighted predicted probability (WPP) of diabetes (0.11; 95% CI, 0.09-0.13) compared with less acculturated individuals with lower socioeconomic status (WPP, 0.17; 95% CI, 0.14-0.19). They also showed a significantly lower predicted probability of hypertension (WPP, 0.10; 95% CI, 0.08-0.12) compared with both less acculturated individuals with lower socioeconomic status (WPP, 0.18; 95% CI, 0.15-0.21) and more acculturated individuals with lower socioeconomic status (WPP, 0.19; 95% CI, 0.15-0.23).

The study's design limited its scope by not including a higher proportion of US-born Hispanic and Latino persons. Researchers did not measure diet quality and physical activity at visit 2, potentially confounding the results by segmented groups due to differential changes in these factors.

The interaction of heritage, acculturation, and socioeconomic status should inform health care systems, clinicians, and policymakers as they develop prevention and treatment strategies to combat the major cardiometabolic health crisis in Hispanic and Latino communities.

References

1. Pérez-Stable EJ, Panigrahi A, Coreas SI, et al. Diabetes and hypertension risk across acculturation and education levels in Hispanic/Latino adults. JAMA Health Forum. 2025;6(3):e250273. doi:10.1001/jamahealthforum.2025.0273

2. Arias E, Johnson NJ, Vera BT. Racial disparities in mortality in the adult Hispanic population. SSM - Population Health. 2020;11:100583. doi:10.1016/j.ssmph.2020.100583